In a meta-analysis of several hundred studies designed to identify relationships between cardiovascular health and cholesterol levels, researchers found that the two most statistically significant variables on decreasing the incidence of major cardiovascular events, defined as hardening of the arteries, heart attacks, and strokes, were high serum HDL cholesterol levels and a high HDL-to-LDL ratio. The researchers also found, after adjusting for confounding variables such as smoking or exercise, that one subset of study participants, those who consumed no animal products and thus no dietary cholesterol, had the lowest HDL cholesterol levels and relatively low HDL-to-LDL ratios, yet suffered a markedly lower incidence of any major cardiovascular event than did any other subset of participants.
Which of the following, if true, most helps to resolve the conflicting findings of the meta-analysis?
Pre-think:
Try to figure out the paradox:
A. high serum HDL cholesterol levels and a high HDL-to-LDL ratio --> low incidence of major cardiovascular (normal people)
B. the lowest HDL cholesterol levels and relatively low HDL-to-LDL ratios --> lower incidence of major cardiovascular events (people who consumed no animal products)
Question type: Resolve paradox--> Find a reason to see why both A and B happen. Notice the gap between A and B is that in B, people in the study do not consume animal products --> Any difference?
(A) The participants who consumed no animal products
represented one-tenth of the total number of participants across all studies, just meeting the standard for statistical significance.
--> Paradox is still there. We want to solve the paradox even if the participants who consumed no animal products represented only a small fraction of the whole.
(B)
The human body is capable of producing all the cholesterol it needs to function, both HDL and LDL, without any dietary cholesterol.So we know participants who consumed no animal products represented still have HDL and LDL. But the paradox is still there because researchers are aware of that stuff. (They did calculate the level of HDL and the ratio of HDL to LDL)
(C) HDL cholesterol is necessary for the removal of fat molecules out of artery walls, thereby increasing cardiovascular function, only when such molecules are derived from animal products.This is the correct answer. C helps us know that participants who consumed no animal products represented have less fat molecules derived from animal products than other participants, then have no need to have HDL cholesterol, and thus no increasing cardiovascular function, which may cause major cardiovascular events.
(D) Because of the duration of some of the studies,
[color=#ed1c24]not all participants accurately reported[/color] what they consumed.
May be just one participant inaccurately reported what they consumed. D is not a strong evidence to solve the existing paradox.
(E)
Earlier studies, which represented half of all the studies analyzed, incorporated methods for measuring serum cholesterol that were later replaced by more refined procedures.
We just focus on the so-called present procedures with the stated results. Paradox is still there.